NURSING 432- FA Chuck Roberts | Interview the Patient | Review - Answers and Rationale.

Chuck Roberts 1. Your wife says she has noticed changes over the past year. Have you noticed any of the changes she mentioned? Rationale Relevancy Your Answer It is important to assess the client’s perspective about his own health. Even though he may not be aware of his cognitive decline with the same specificity or accuracy of his spouse, it is critical to gain his input and insight into the chief complaint. Relevant Relevant Client: You know, there’s really nothing wrong with me other than getting older. Sometimes it’s hard to remember where I put something or where we are going that day, but that’s the only thing…and I know that comes from old age! 2. When you are feeling confused, have you been running a fever? Rationale Relevancy Your Answer Fever is associated with episodes of delirium, not dementia. Irrelevant Irrelevant Client: I haven’t had any fevers. 3. Have you noticed that one side of your body is weaker than the other? Rationale Relevancy Your Answer Unilateral weakness is association with cerebrovascular accident (CVA) and transient ischemic attacks (TIA), not dementia. Irrelevant Irrelevant Client: No. Both sides seem the same. 4. You said that sometimes you forget where you are going or where you put something. Are you able to remember things from long ago, such as your wedding to Mrs. Roberts? Rationale Relevancy Your Answer Alzheimer’s disease is characterized by memory impairment or the impaired ability to learn new information or recall previously learned information. Most clients in the early stages of Alzheimer’s disease will still have clear recollection of events long Relevant Relevant past. Client: Of course. It was in the middle of February of 1958 with snow up to my knees. How could I forget that? 5. Are the hand tremors that you experience while at rest worsening as your memory declines? Rationale Relevancy Your Answer Hand tremors are associated with Parkinson’s disease, which can also cause a progressive deficit in memory and cognition. However, Mr. Roberts’ diagnosis has already been established as early Alzheimer’s disease, and there are no other issues in the chief complaint to indicate that this is a new concern. Irrelevant Relevant Client: I don’t have those. 6. Do you find that you get upset or frustrated more easily now than you did last year when we saw you? Rationale Relevancy Your Answer An increase in a clinically significant behavioral disturbance, such as wandering or agitation, can accompany a progression in Alzheimer’s disease. Therefore, it is important to know if Mr. Roberts has developed further accompanying symptoms as his wife stated. Relevant Relevant Client: Well, of course I get more frustrated than normal. Mrs. Roberts here is on me all the time about forgetting things and it just gets on my nerves. I guess I just get irritated and then say things that maybe I shouldn’t. It just ticks me off when she keeps asking me about forgetting things, and then I let her know what I think. 7. Have you noticed any difficulty speaking over the past 12 months? Rationale Relevancy Your Answer Although language disturbance (aphasia) can be associated with a number of cognitive disorders (e.g., stroke), it is also one of the potential diagnostic criteria associated with later stages of dementia of the Alzheimer’s type. In addition to memory Relevant Relevant impairment or the impaired ability to learn new information or to recall previously learned information, Alzheimer’s clients will exhibit at least one additional symptom such as aphasia, apraxia, agnosia, and/or disturbance in executive functioning (planning, organizing, sequencing, abstracting). With this in mind, it is important to understand if Mr. Roberts has any of these additional symptoms associated with dementia of the Alzheimer’s type. Client: Nope. I speak just fine. I never have trouble finding words to say. I always know what I want to say